Play episode

A mockingbird singing from a blossoming cherry tree. We talk about cancer staging in this episode, and explain the TNM nomenclature. https://every1dies.org

March 14, 2025

S5E50: What is Meant by Cancer Staging? Learn the Language of a Cancer Diagnosis

Cancer staging is very important to guide treatment decisions and eligibility in studies. When an oncologist delivers a diagnosis it will include stage, but what does that mean? After an agonizing period of tests, waits for results, and finally an answer, many people go numb as soon as they hear the word “cancer” and fail to ask for clarification about terminology. Learn what you need to know to be an active participant in your care.

In This Episode:

Transcript

01:45 – Recipe: Alabama Lane Cake, featured in “To Kill a Mockingbird”
03:13 – A Short Guide to a Happy Life by Anna Quindlen
07:23 – What You Need to Know About Cancer Staging
09:48 – The Exceptions to Staging
11:02 – Understanding Staging with a Stomach Cancer Example
18:11 – Cancer Staging Sub-Categories
20:44 – TNM Categories
24:15 – Discussion – Thoughts About Stage 4
30:22 – A Letter Attributed to David Bowie, Who Died from Liver Cancer
32:57 – Outro

What is Cancer Staging?

Our focus today is to help you understand the cancer staging system. The stage of disease measures if the cancer has spread, and how far is has spread from where it started. Cancer staging is a way to communicate the extent of cancer in the body so that everyone involved is speaking the same language.

Cancer Staging Example: Stomach Cancer

Marianne used stomach cancer as a way to understand staging. You can use the image below and follow along as she describes the anatomy.

You can also refer to the National Cancer Institute explanations:

Marianne also shared about cancer sub-categories, such as 1a, 2c, etc. This further refines the definition of how far the cancer has spread.

Cancer Staging with TNM Categories

The Tumor-Node-Metastasis notation is an even more refined way to define the extent of cancer spread. TNM helps to establish the anatomic extent of the disease, and the combination of the 3 factors can define the overall tumor stage. This method allows for simplification, with cancers staged from I-IV, with stage IV being the most severe stage.

Cancer Staging with TNM Categories
Stage	Meaning	TNM
0	Indicates carcinoma in situ	Tis, N0, M0
1	Localized cancer	T1-T2, N0, M0
2	Locally advanced cancer, early stages.	T1-T2, N1, M0
3	Locally advanced cancer, late stages.	T1-T4, N2-N3, M0
4	Metastatic cancer.	T1-T4, N1-N3, M1

TNM Classification – StatPearls – NCBI Bookshelf

Is Cancer Stage the Same as Grade?

One thing that is often confused is Tumor Grade vs Stage. This can cause extreme worry thinking one has advanced cancer, when this is actually referring to the cell characteristics.

Tumor grade describes how normal or abnormal cancer cells look under a microscope. The more normal the cells look, the less aggressive the cancer and the more slowly it grows and spreads. On the other hand, the more abnormal the cells look, the more aggressive the cancer and the faster it is likely to grow and spread.

Tumor grade describes how normal or abnormal cancer cells look under a microscope. On the left is closer to normal cells, on the right, it looks very different. The higher the grade, the more abnormal the cells look and the faster it is likely to grow and spread. (cancer.gov: Tumor Grade)

Tumor grade is not the same thing as cancer stage. Stage refers to how large a cancer tumor is and how far the cancer has spread. See Cancer Staging to learn more.

It is possible to have a high-grade (aggressive cancer) with low stage. An example would be a Grade 3 DCIS breast cancer that is still in situ, or stage 0. Even though the cells have changed considerably, they have not yet broken out of the milk ducts in the breast. This has a very good prognosis because the cancer has not spread. So don’t confuse Grade 3 with Stage 3.

Related Episodes:

Live Deeply Every Day

Charlie read an excerpt from the book “A short Guide to a Happy Life”, by Anna Quindlen, the bestselling novelist and columnist. In it she reflects on what it takes to “get a life”—to live deeply every day and from your own unique self, rather than merely to exist through your days. You can pick up a copy of the book here on Amazon.

How David Bowie Faced Death

Charlie read a letter attributed to David Bowie, who turned his terminal liver cancer diagnosis into a challenge to complete one more work. Bowie died on January 10, 2016 from liver cancer, but not before releasing his Blackstar album on 8 January 2016, coinciding with his 69th birthday.

I will die… I know there are only a few months left until the end of my earthly journey…
What should I do? Despair, sink into depression, reject the idea of death, and pretend the illness doesn’t exist?

Or should I decide to defeat death… I decide it with my soul because only the soul and the heart give me the inspiration to compose music, as I’ve done for 50 years…

I count the hours I have left, and as the doctors tell me, I can predict, within a certain margin, the date of my death. The release of my last work is scheduled for January 8, 2016, my 69th birthday.

I work day and night; I have the time to compose, perfect, perform, record in the studio, and make videos… I do it as quickly as possible because I don’t want my face to show the mark of death, which mockingly is cutting down my body without me being able to defend myself…

But I challenge you, death… To hell with it if I don’t challenge you!
I challenged and conquered the world of fans in the '70s with the pride of ambiguity… I loved men and women; I was a man, a woman, an alien, and finally, a celestial body.

What can you do, death, against my eternity, my genius, my madness, my creativity, my music that will live forever?

I am Lazarus, torn from the scars. I will die in the body, but I will live forever through my music.

I lived long enough to receive birthday wishes. I thought I wouldn’t make it to see my album released… I survived January 8… And you, my dear killer, lost!

Just think, if you hadn’t knocked on my door, I would have created 24 works; I would have managed to live to 100, and instead, thanks to you, I have 25!
You know… I will be free as a bird.

Recipe of the Week: Alabama Lane Cake

Get this recipe from MomLovesBaking. Don’t forget the booze!

References:

Resources:

**We are also selected as one of the Top 50 Grief Blogs on the Web!**
https://blog.feedspot.com/palliative_care_podcasts/

Goodpods Top 100 Death Podcasts Listen now to Everyone Dies (Every1Dies) podcast

Everyone Dies: and yes, it is normal!

Everyone Dies (and yes, it is normal) is a story about a young boy named Jax who finds something special on the beach where he and his grandpa Pops are enjoying a wonderful day. Pops helps Jax understand that death is a normal part of life. This book provides an age appropriate, non-scary, comfortable way to introduce the important topic of mortality to a preschool child. Its simple explanation will last a lifetime. Autographed copies for sale at: www.everyonediesthebook.com. Also available at Amazon

Mourning Jewelry

We offer a way to memorialize your loved one or treasured pet with a piece of handmade jewelry. When people comment on it and the wearer can say for example “I received this when my mother died” which opens the conversation about this loss. All our jewelry is made with semi-precious stones and beads, vintage beads, and pearls. You can choose between earrings or bracelets and the color family. Learn More